This study introduces a technique for systemically observing the consequences of various aspects of treatment on the communicative effectiveness of nonspeaking persons using communication boards in natural settings. The case study of Kay, a 24-year-old nonspeaking woman residing in a nursing home, is presented. Three major factors were found to operate cumulatively in increasing Kay's overall communicative effectiveness: 1) revising the design of her original communication board; 2) training her to functionally use her new board to meet her daily communicative needs; and then 3) introducing interaction strategies to her listeners through an inservice training program. Highlights of Kay's and her staff's programs are discussed.